Graduation Year

2019

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Community and Family Health

Major Professor

Stephanie L. Marhefka, Ph.D.

Committee Member

Bruce Lubotsky Levin, Ph.D.

Committee Member

Guitele J. Rahill, Ph.D.

Committee Member

Julie A. Baldwin, Ph.D.

Keywords

depressive symptoms, Nepal, post-disaster, PTSD symptoms

Abstract

Background: Adverse mental health outcomes have been previously reported among survivors of natural disasters. Available studies mostly focus on risk factors and not resilience. In 2015, a series of earthquakes caused massive loss of lives and livelihood in Nepal. Epidemiological data pertaining to youth mental health in Nepal is limited. Information about the post-earthquake mental health of youth who were exposed to earthquakes during their adolescence in Nepal is scarce.

Purpose: The purpose of this study was to address risk and resilience factors related to mental health among college-attending Nepali youth (18-20 years) exposed to the 2015 earthquake during their adolescence (15-17 years), utilizing a mixed-method study design. This was achieved through the following two specific aims: 1) Describe the relationship between the extent of earthquake exposure to self-reported current depressive symptoms (outcome 1) and PTSD (outcome 2) among youth exposed as adolescents in post-earthquake Nepal; and 2) examine the perceived risk and resilience factors pertaining to mental health among youth exposed to the earthquake as adolescents in post-earthquake Nepal.

Methods: An explanatory, sequential, mixed methods design was used in the present study. In Phase 1, a self-administered paper survey was used to collect data related to socio-demographic variables, the extent of earthquake exposure, depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, resilience and other risk and protective factors pertaining to mental health of youth (N=125). Scores for outcome 1 and 2 were computed and participants eligible for Phase 2 were identified. The eligible participants were divided into two groups. Group 1 (n=26) included individuals who have scored in the first quartile for both outcomes, signifying they were less likely to have those outcomes. Group 2 (n=39) included individuals who had scored in the fourth quartile for either of the two outcomes, signifying they were more likely to have either of the two outcomes. Then, 12 participants were randomly selected form each group and were followed up with in-depth interviews. The interviews were conducted in Nepali language, audio-recorded, translated into English, and transcribed. Thematic analysis was conducted to explore the difference in risk and resilience profiles between the groups. In some cases, survey results from Phase 1 were used to triangulate the qualitative findings and vice-versa.

Results: At the multivariable level, after controlling for other variables, for one unit increase in the extent of earthquake exposure, the odds of participants likely to have depressive symptoms increased by factor of 1.26 (95% CI: 1.09-1.45; p<0.01) post-earthquakes, and the odds of participants likely to have PTSD symptoms increased by a factor of 1.26 (95% CI:1.13-1.61; p<0.01) post-earthquakes. Having a complicated romantic relationship was also associated with the likelihood of having depressive symptoms post-earthquakes. Similarly, with every additional unit of exposure, the difference in depressive scores increased by 0.31 (t=3.61, p<0.001) and the difference in PTSD scores increased by 0.20 (t=2.31, p=0.02). While all participants were exposed to the earthquakes, their level of exposure, experiences and impact were varied. Group 2 participants reported higher levels of exposure, along with other risk factors such as inter-parental conflict, experiences of discrimination and being in complicated romantic relationships. Strong parental support and involvement (or lack thereof) was another important factor related to resilience in this population.

Conclusion: Results of the study indicated that the extent of exposure to earthquake, along with parental involvement, being in a complicated romantic relationship and discrimination were related to adverse mental health outcomes among youth attending a college in Kathmandu. Future studies should look into ways these factors affect the mental health of youth, both exposed and unexposed to a natural disaster. Mental health of youth is an important tenet of public health. Increased focus on mental health could help achieve some targets set by the National Youth Policy of Nepal. In addition to targeting risk factors, protective factors need to be cultivated, which means identifying these factors locally and nationally and incorporating this into policy-making and programmatic actions.

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